Your Questions

Q: Dr. Eppley, Can a custom chin implant fix a step deformity from a previous 10 mm genioplasty and add some extra projection as well (~5-6 mm)? I’m a patient that was born with extreme microgenia but with proper jaw alignment and teeth position, it’s just that the size of the chin is extremely small. So I went to a maxillofacial surgeon and got a 10 mm genioplasty that was properly done, the only thing I did not like was that they did not use cadaveric bone chips to cover the step off and now the chin looks more like a stair instead of being convex. The problem is that the horizontal projection is still not enough even after the 10 mm genioplasty and that the chin lost its convexity. That’s why I asked the same maxillofacial surgeon if it was possible to fix everything with a custom implant and he told me that it was too risky because it could get infected, since it would be too close to the tooth roots and the mouth. Do you agree with this? I can’t leave it like this, I need to find a solution.

A: In larger sliding genioplasty movements the greater the likelihood of inferior border irregularities and  a disconnected look of the chin can result if the angle of the bone cut is too oblique. For some additional horizontal advancement and coverage of the inferior border defects a custom chin implant would do so effectively.

The statement ‘ it was too risky because it could get infected, since it would be too close to the tooth roots and the mouth’  has no biologic basis. A custom chin implant is placed through a submental incision. It is a common secondary genioplasty procedure and I have done it many times.

Dr Barry Eppley

Plastic Surgeon

Q: Dr, Eppley, I am writing to inquire about surgical options for modifying the mandibular angle (gonial region), specifically to increase its lateral/outward projection.

Currently, my gonial angles appear to flare slightly inward, which reduces their visibility in profile and contributes to a weaker overall jawline. I am interested in achieving a more laterally prominent, everted gonial morphology, which I associate with a stronger and more defined male jawline.

I recall having seen a procedure conceptually similar to a chin wing osteotomy, in which a segment of the inferior mandibular border is osteotomized and repositioned to alter lower facial structure. The standard chin wing osteotomy appears to primarily influence the anterior mandible and chin region, with relatively limited direct modification of gonial projection. I would like to know whether any segmental repositioning techniques exist that more directly target the gonial region or the posterior mandibular body/ramus transition.
Mandibular angle reduction or narrowing procedures (e.g., V-line reduction) typically involve the region I am interested in modifying. My question is whether it would be possible to allow for augmentation or lateral repositioning of the existing gonial angle complex, ideally through bone-preserving osteotomies rather than implant-based augmentation.
For context, I have attached three illustrative references: 1. The first image shows different mandibular flare patterns. In this diagram, A and B represent female mandibles, characterized by more inward or straighter gonial angulation, while C represents a male mandible with a more outward/everted gonial flare. The latter (C) corresponds more closely with my aesthetic goal. 2. The second image illustrates a chin wing osteotomy. While this demonstrates the principle of segmental osteotomy and repositioning of the inferior mandibular border, it appears to primarily influence the chin and anterior jawline, with limited direct alteration of gonial projection. 3. The third image is based on mandibular angle reduction (V-line), which highlights the specific bony segment typically removed in such procedures. My interest is whether this segment, particularly the portion extending toward the gonial angle and ramus transition, could instead be mobilized and repositioned laterally to increase gonial prominence rather than excised. I am not interested in implant-based approaches. I also understand that non-vascularized onlay grafting in this region may be unpredictable and prone to resorption. I would appreciate your perspective on whether any reliable skeletal techniques exist to achieve this type of modification, or whether implants remain the only predictable option.

Thank you for your time and consideration.

A: It is very common that the ramus (jaw angle) flares inward rather than outward. There is no osteotomy that will make the jaw angle have an outward flare or prominence. Jaw angle augmentation can only be done by implants.

Dr Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, can orbital and midface implants be done on a patient who previously had implants placed behind the eyes to treat enophthalmos?

A: Yes it can. I assume the enopthalmos implants are orbital floor implants.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello. I would like to discuss the possibility of getting a custom sized testicular implant. I currently have a prosthesis. The prosthesis is about 12 months old. It replaced another prothesis that I had. This one is the largest size Coloplast. But it is still significantly smaller than my other testicle. I’m not happy with it. I’m looking for a custom solution.

A: Given that the largest saline testicle implant size is 4.5 cc you are correct in that a custom implant design is needed as you probably need an implant at least 5.25 to 5.5 cc to match your opposite side. Whether it needs to be even bigger is yet to be determined.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I had a genioplasty in late 2025. My chin position looks good, but when I smile I notice some fullness or hanging under the chin area. I am about 7 months post-op and would like to know if a minor soft tissue procedure might be appropriate to remove it so the chin is not hanging when I smile.

A: Your genioplasty appears to have driven your chin downward creating this abnormal fold of chin pad when you smile. I don’t believe that is correctable by soft tissue excision as it is caused by the bone position.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Would you do shoulder reduction rib removal and back lift in one surgeryI’m interested in a upper lip vy plasty laterally to make the sides and corners have more volume and be more flipped

A: Thank you for your inquiry and sending your pictures. The combination of shoulder narrowing, back lift through which the river removal would be done and upper lip Y lengthening can be done in a single surgery in the properly selected. Patient proper selection refers to the patient’s prior surgical experience, their overall health, and what is their support system going to be like right after surgery in the early recovery process. As you can see, this is a multi factorial answer to which each patient must be assessed on an individual basis.

I would say, on average, that is a lot of surgery for one patient to undergo but in properly selected patients I had done so successfully.

Dr. Barry Eppley

Plastic Surgeo

Q: Dr. Eppley, I had an ineffective horizontal projection chin reduction surgery about 5 years ago that only seems to get worse with time. The surgeon did it orally, and burred the bone down, but the fat pad was not properly taken care of and it now projects the same and scrunches oddly at the front and bottom when smiling. I can feel the -bone- properly reduced now when I examine my jaw, but the chin pad is thick and can be grabbed. I’ve been wanting a revision for chin pad reduction and have been considering surgeon and timing, and I saw that Dr. Eppley has success in these exact cases like mine

A: Intraoral bony chin reduction for a horizontal excess is a flawed technique as it fails to address the soft tissue excess. Such chin pad excess must now be addressed by an external submental excision technique.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I have very very dark circles I tried everything to get rid of it but does not work so was thinking of orbital rim implant

A: Dark circles are often a combination of shading from undereye hollows and hyperpigmentation particularly in certain skin types.If you have significant undereye hollowing orbital rim implants may be helpful but rarely will completely eliminate the dark circle appearance.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, For skull reshaping, what does the recovery process and timeline look like?

A: Skull reshaping is a general term that refers to over 30 different procedures who have various surgery and recovery times. Without knowing what exact skull reshaping procedure to which you refer I can only provide a general statement based on a lot of clinical experience… it is usually much faster than one would think.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Removal of titanium plates and screws in upper and lower jaw. The titanium plates and screws are causing health problems and I would like to have them removed.

A: The removal of maxillary hardware is generally 100% doable. The key is what the mandibular SSRO hardware looks like as that is always the bigger challenge. They coild be plate and screws or they could be bicortical screws. They are also more prone to having some bone over growth.

A simple panorex x-ray is needed to evaluate the type of hardware present.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I was born with a genetic disorder called Treacher Collins Syndrome, which led to underdeveloped upper and lower jaw bones. When I was 19 I had jaw surgery to correct this and have multiple titanium and stainless steel plates and screws in both my upper and lower jaw. I am now 49 years old. I have always suspected that the hardware may be contributing to some of the symptoms that I have experienced over the years, which have only increased in severity and frequency as I get older. I read that Dr. Eppley has had a lot of success in removing hardware. I am very aware that it may be a challenging case given the amount of time that has passed but I am holding on to the hope that he is the one who can help me. Would a virtual consultation be recommended for next steps?

A: The removal of maxillary hardware is generally 100% doable. The key is what the mandibular SSRO hardware looks like as that is always the bigger challenge.

A simple panorex x-ray is needed to evaluate the type of hardware present.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello I had pmma cement done on 2023 since then I got many revision due to abnormal results lumps, last revision was in 025. I would like to know if it’s possible to do a total removal and replace with custom peek implant. I really want to keep the volume but I am done with cement. I was told by other surgeons that custom PEEK implant will have edges showing and still look not normal, is that true? Thank you

A: PMMA bone cement forehead augmentations can be prone to irregularities which can be hard to correct as you have experienced particularly if it has been done through a limited incisional approach.

It would be helpful to know what type of incisions was used for your PMMA forehead augmentation.

 It is accurate to state that PEEK implants do not have feathered edging because it is a machined or milled implant. Such non-feathered edging will be visible in a large skull area such as the forehead. This leaves you with two options: 1) do intraoperative implant edging reduction by hand and hope it to be successful, or 2) make a solid silicone custom forehead implant that has feathered edging by its manufacturing methods.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, Hello, I would like to schedule a consultation for male chest enhancement. My goal is to achieve a clearly defined, masculine and athletic result, with: – significant pectoral volume (not subtle) – good upper chest fullness (clavicular area) – a natural but strong, bodybuilder-type appearance I am also interested in combining this with abdominal liposculpture (ab etching) for a complete aesthetic result. My current stats: – Age: 48 – Height: 180 cm – Weight: 73 kg I already have a relatively lean physique but lack volume in the chest, especially the upper part. I would like to know: – if I am a good candidate for combined surgery – what implant type and size you would recommend (I am open to larger/custom implants if appropriate) – if upper chest enhancement (lipofilling or technique) can be optimized – recovery time and total cost estimate To better illustrate my expectations, I am attaching an example of an implant shape that corresponds more closely to the result I am aiming for. I am particularly interested in: – a taller implant that covers more of the upper chest – a shape that enhances the clavicular (upper) area – a stronger projection for a more structured and masculine appearance I understand that the final choice must be adapted to my anatomy, but I would like to achieve a result closer to this type of volume and distribution rather than a moderate or subtle outcome. Could you please let me know if this type of implant geometry (or something similar) can be considered in my case? Thank you very much.

A: What you are seeking in pectoral implant augmentation is a contemporary implant approach with a more vertical implant design that has equal or greater thickness near the clavicle. Whether the footprint of the implant can be done by a standard implant or a custom designed one depends on your specific pectoral muscle measurements. When you factor in the desire for ‘significant’ pectoral implant volume (generally > 500ccs) it is likely that a custom implant design is needed.

But the first place to start is to have me look at some chest pictures where I can show you how to take muscle meaurements.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, A surgeon attempted to remove my twenty-year-old Medpor cheekbone implants and was unable to do so because the implant osseointegrated with the cheekbone and remained fixed. Does “osseointegration” definitely indicate that the implant must remain to avoid facial deformities? Also, if the implant could somehow be removed, would replacing it with another implant be the only way for the area to appear normal?

A: In my vast experience with removing Medpor facial implants I have never seen any evidence of bony ingrowth into the implant. Only at the jaw angles have I seen some bony overgrowths (not ingrowth). In the cheek area in particular I can not imagine bone ingrowth and even if there was the implant should still be able to be removed.

Whether any implant is needed after the removed Medpor implant or not to look ‘normal’ depends on numerous factors such as the size of the removed implant, how much tissue dsag exists and what you define as looking normal.

Dr. Barry Eppley

Plastic Surgeon

Q: Dr. Eppley, I’m considering infraorbital and malar implants. I’m from Germany . What are the next steps? virtual meeting or would you like photographs? I’ve had a couple of consults, my questions and their responses below: Are custom implants necessary? both doctors said no Do you provide imaging to design the implants? both doctors said no Do infraorbital and malar implants come in a combined single piece? One doctor said he’s going to check

A: 1) There are no standard infraorbital-malar implants, only surgeons trying to use a standard implant style to try an create the same effect…which never works out well.

2) When surgeons tell patients they don’t need a custom implant, almost always it is because they don’t do them and have never done them. They do the type of surgery they know how to do which you had better hope matches what you actually need.

 This then takes up back to point #1…what do you really need and what is the best way to accomplish it.

Dr. Barry Eppley

Plastic Surgeon

Q: De. Eppley, my name is María, and I am writing to you from Spain because I recently read an article of yours about perioral mounds. I have an upcoming appointment to reduce them with Endolift. Are you familiar with this procedure?

Do you think it can be effective? I would greatly appreciate your opinion, as very few people seem to address this topic.

Many thanks in advance.“

A: Do I think an Endolift will resolve perioral mounds……no.

If it does provide any improvement it will be very temporary.

You can’t lift away perioral mounds

Dr. Barry Eppley

Plastic Surgeon